Healthcare Reform

We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily agree with 100% of the details of every article, I think the messages are salient, on target, and fully relevant.  Please give us your feedback – and let us know if you find the series helpful.

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Woody Allen notoriously maintained that “The heart wants what it wants.”

Mr. Allen thought that all that mattered when he married his daughter-in-law was his heart. But, from the standpoint of the public, the type of relationship sometimes matters as much as the bond between the two parties.

When there is a personal relationship between a doctor and a patient, society – in the form of state medical boards and the courts – will likely be in the bedroom as well.

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In our data driven word, you know what’s around the corner. Report cards for doctors based on clinical outcomes. But, statistics is a funny thing. Michael Blastland, a journalist with BBC, made precisely this point with his Go Figure Chance Calculator.

 

His premise:

 

“Imagine you are a hospital doctor. Some patients die. But how many is too many before you or your hospital are labeled killers?”

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The holy grail for bean counters who focus on healthcare quality are tools for patients to help them find the best doctors. The argument goes: transparency will help drive quality initiatives; the data will help patients find the better doctors.

 

The process took off in 1986 when the Health Care Financing Administration released report cards of hospital-specific, risk-adjusted mortality rates for coronary artery bypass surgery. In 1991, New York picked up the baton by releasing stats for individual surgeons for risk-adjusted mortality rates for coronary artery bypass surgery. So, this data has been around for over two decades.

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We learned of a case where a patient was injured at a hospital. The treating doctor and the hospital were sued. Doctor decided to settle for policy limits – $1M. He believes he got out early and can sit on the sidelines. He reasonably believes his involvement in the case is over. And the hospital may be on the hook for a larger sum.

 

The hospital sues the doctor – arguing that if a jury orders them to pay, they want the doctor’s group to underwrite some of that payment. In other words, they want to be reimbursed some of the money a jury holds them liable.

 

What happened here?

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Dr. Nikita Levy was a gynecologist affiliated with Johns Hopkins. He secretly photographed and videotaped women’s bodies in the examining room. When I say secretly, I mean without their knowledge or consent. Dr. Levy apparently wore a pen-like camera around his neck to accomplish the deeds.

 

In February, 2013, an employee alerted hospital authorities which forced the doctor to turn over his camera. Investigators discovered 1,200 videos and 140 images stored on servers in his home.

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We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily agree with 100% of the details of every article, I think the messages are salient, on target, and fully relevant.  Please give us your feedback – and let us know if you find the series helpful.

Dirty Harry said, “A man’s got to know his limitations.”

The best general medico-legal advice is to do nothing that is not fully within your technical and knowledge comfort zone. When you move outside your specific area of expertise you will be held to the Standard of Care of an experienced and qualified practitioner in the area you have entered.

However, real life as a practicing physician has a tendency to not cooperate with the ideal.

Recently, two physicians raised questions about how to handle moving outside that ideal zone of practice, one in an elective setting and one in an emergency setting.

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A plastic surgeon called me recently. He routinely examines his female patients with a female chaperone in the room. This is a good idea. Make that – a great idea. While it’s not common to be accused of inappropriate sexual contact, the accusation does occasionally happen. Then, it’s he said, she said. Write a big check.

 

This patient said she did NOT want any such chaperone in the room as it would create “negative female energy.” Huh?

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We continue with our series of general educational articles penned by one attorney, an MD, JD, giving you a view of the world through a malpractice plaintiff attorney’s eyes. This attorney is a seasoned veteran.  The series includes a number of pearls on how to stay out of harm’s way. While I do not necessarily agree with 100% of the details of every article, I think the messages are salient, on target, and fully relevant.  Please give us your feedback – and let us know if you find the series helpful.

Treating patients in pain with opioids creates serious legal quandaries for doctors.

A 2010 study (based on the American Society of Anesthesiologists Closed Claims Database) found that malpractice claims related to chronic non-cancer pain management primarily involved patients with a history of risk behaviors.

The study also found that death was the most common trigger of these claims.

Prescribing opioids causes a conflict. No doctor wants to undertreat the patient in pain. No doctor one wants the excess liability created by patients who are addicts, criminals, or a complex mishmash of unrelenting pain issues and co-morbidities.

On the other hand, that study also found that 59% of claims were grounded in physician mismanagement, either on its own or compounding a patient risk factor.

This means doctors still control the legal destiny of these cases. Steps can be taken to reduce the physician’s risk of being prosecuted as a “pill mill” or being held responsible for the dangerous or felonious use of the medication by the patient.

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Most physicians wake up every day intending to do the best possible job and help their patients. They work long hours, sacrifice a normal family life, and don’t always receive a thank-you note.

 

Digest the following hypothetical.

 

You and your partner are the only neurosurgeons for a small community of 50,000 people. The draw area is larger, say 250,000. The closest major metro area is 80 miles away. And that city has a medical school, teaching hospitals, and full service trauma treatment.

 

You and your partner alternate call for both the practice and the ER.

 

Your partner is on call.

 

You’ve had a long week, and are ready to kick back. In anticipation of the weekend, you just finished a large glass of Cabernet. Yum.

 

The ER calls and you pick up the phone. You didn’t have to. But you did.

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